57something that is inaccurate and/or disparaging, for instance, if a patient says “I’m
sure this is my fault. If I’d only been more careful earlier in the pregnancy, my baby
would be ok.” In this case you may intend to communicate that you understand what
the patient said, but the patient might interpret your head nod as agreeing it is in fact
her fault.
Body
Effective use of your body refers to maintaining relaxed but alert posture, using
occasional hand and arm gestures for emphasis, keeping your legs and feet still (no
leg or foot jiggling), positioning yourself so you face the patient as directly as pos-
sible and sitting with an open stance (uncrossed arms and legs), and sitting at a
distance that is comfortable for the patient. If you work behind a desk, position the
patient chairs to one side and move your chair to that end of the desk in order to
minimize the desk as a physical barrier.
Voice
Effective vocal attending includes speaking at an adequate volume, maintaining
an appropriate pace or speed, using inflections, using words the patient can under-
stand (be careful about “talking down” to patients, which usually happens if you
use simple words in combination with a “singsong voice” and exaggeratedly slow
pace), and using a tone that matches the content and tenor of the conversation.
Distracting Behaviors (Behaviors to Avoid)
We are all prone to engage in distracting behaviors when we feel anxious, preoccu-
pied, and/or otherwise are not fully engaged with a patient. Distracting behaviors
include habitual, informal word choices (e.g., “you guys” which, although quite com-
mon in US vernacular, is very unprofessional in a genetic counseling setting); exces-
sive use of filler words (you know, right, ok, it’s like..., um, etc.); shuffling through
notes and/or focusing on a computer rather than looking at the patient; playing with
something like a pen, jewelry, or paper clip; twisting your fingers or hair or clenching
your hands together; jiggling your foot; and chewing gum (also very unprofessional).
Touching Patients
Touch can be beneficial if it leads to an improved relationship but harmful if the
patient views it negatively. In the context of genetic counseling, as with other medi-
cal interactions, lightly touching a patient after giving bad news may be a normal,
3.3 Effective Counselor Physical Attending Behaviors